16 More Ways To Fix A Very Bad Senate Bill

Now that the first (although least controversial of my ideas) to fix the terrible Senate bill appears likely to be adopted in the conference committee, now is no time to let up. I see their one improvement, and raise them another 15 changes that need to be made. Here are 16 more ideas to add to my original list of 35 ideas:

1. Extend everyone's COBRA coverage until the reform kicks in (like in the House bill).


2. Better define the term "medical loss ratio" in the bill to prevent insurers from gaming the regulation.


3. Give the IRS power and duty to enforce insurance companies' MLR regulation.


4. Remove the six-month wait for the temporary high-risk pools for people with pre-existing conditions. If you can't get affordable health insurance, it is immoral that the bill makes you go uninsured for six months before you get care.


5. Set up the exchange and all corresponding regulations for small business as soon as possible (a few months). They delayed the exchange because the regulations in the individual market require the expensive affordability tax credits. The small business market will not get expensive affordability tax credits, so there is no reason not to start the exchange just for the small group market as soon as possible.


6. Let insurers in the new exchange use a reimbursement rate based on Medicare plus some percent. (This idea from Jacob Hacker would have similar cost controlling effects as my previous suggestion of having the exchange commissioner force all insurers using PPO's to negotiate one standard provider reimbursement rate.)


7. Use the OPM exchange to replicate something similar to the Swiss or German system. (Only allow only new CO-OP plans to take part. Mandate a 93% MLR, precisely define benefit packages, and have them collectively pool their negotiating power with providers and manufacturers. Make all co-ops on the OPM exchange share provider networks, reimbursement rates, and forms for PPOs plans or out-of-network charges. Create a robust internal risk adjuster and give all plans in the OPM exchange the power to reimburse at Medicare rates plus 10% for the first several years while the co-ops and OPM exchange gets off the ground.


8. Allow people below 190% of FPL, but who are not poor enough to qualify for Medicaid, to buy in to the program.


9. At least allow people who were on Medicaid but have incomes that increase just slightly above the Medicaid qualification cut off to “buy in” to Medicaid so that they can keep a seamless coverage despite minor fluctuations in income.


10. Fully Federalize the whole Medicaid program.


11. Provide serious special benefits to insurance plans that score very high on precisely defined sets of metrics (MLR, cost effectiveness, consumer reviews, survival rates, speed of claim reimbursement, easy of appeal process, customer retention, etc.)


12. Encourage states and local governments to find a way to merge their state employer insurance exchanges with the new exchange as long as it can be done in a way that does not reduce the quality or increase the cost of coverage for state employees.


13. Encourage community health care centers to work together to create new fully integrated, cost-effective health care plans to cover individuals in Medicaid, the new “basic health program,” or on the new exchange. (like the Community Health Network of Connecticut)


14. Have all insurance plans that provide coverage for young children have zero cost sharing for the health care of the child.


15. At least make all health insurance plans covering children have extremely low co-pays, deductibles, and out-of-pocket limits for the coverage of the child.


16. Have all young children in the country without insurance coverage, regardless of legal status, automatically enrolled in some form low out-of-pocket public health care program. (No child on US soil or anywhere else on Earth should ever die due to lack of access basic affordable health care.)

The more I think about the Senate health care bill, the more glaring failures I see in its design--but pointing out that there is a problem is always the first step towards fixing any problem. Maybe if supposed "liberal/progressive" media spends more time drawing attention to all the failings in the current Senate bill, and less time telling the grassroots they need to just accept any awful bill, the bill would not be so terrible.